Provider Demographics
NPI:1205991296
Name:SMITH, SAHBRENNAH (MD)
Entity type:Individual
Prefix:
First Name:SAHBRENNAH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5015
Mailing Address - Country:US
Mailing Address - Phone:913-682-2600
Mailing Address - Fax:913-682-2622
Practice Address - Street 1:3601 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5015
Practice Address - Country:US
Practice Address - Phone:913-682-2600
Practice Address - Fax:913-682-2622
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110656Medicare ID - Type Unspecified
KSG68055Medicare UPIN